Effect of Transcranial Direct Current Stimulation on Neurorehabilitation of Task-Specific Dystonia: A Double-Blind, Randomized Clinical Trial

2015 ◽  
Vol 30 (3) ◽  
pp. 178-184 ◽  
Author(s):  
Jaume Rosset-Llobet ◽  
Sílvia Fàbregas-Molas ◽  
Álvaro Pascual-Leone
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Severity Score ◽  
Complete Recovery ◽  
Focal Dystonia ◽  
Double Blind ◽  
Direct Current Stimulation ◽  
Right Hand ◽  
Randomized Design ◽  
Sensory Motor

Task-specific focal hand dystonia can disable affected individuals. Although neurorehabilitation techniques such as sensory motor retuning can result in complete recovery in some patients, it requires many months of treatment. Combining transcranial direct current stimulation (tDCS) with neurorehabilitation is a new and promising approach that can help these patients. However, the results in different studies are contradictory. OBJECTIVE: Analyze whether delivering tDCS (cathode over left and anode over right parietal region) during the neurorehabilitation process for musicians with dystonia can increase the effectiveness of therapy. METHOD: A parallel double-blind randomized design was used to study 30 musicians with right-hand primary focal dystonia. All patients underwent a 2-week course of neurorehabilitation based on sensory motor retuning therapy coupled with either real or sham tDCS for the first 30 minutes of each daily 1-hour therapy session (total 10 sessions). The therapist and patient were blind to the tDCS condition. A dystonia severity score was obtained before and after the 2-week protocol. The therapist also rated the evolution of each patient. RESULTS: Both groups significantly improved their dystonia severity score during the 2 weeks. Score differences were 88.23 (±40.51) and 63.36 (±30.57) for the active and sham groups, respectively. The active group showed a statistically significant greater improvement. CONCLUSIONS: Biparietal tDCS with left-sided cathode is a safe technique that does not interfere with the neurorehabilitation procedure and can increase therapy effectiveness in rehabilitation patients with right-hand task-specific focal dystonia.

scholarly journals Exploring the neural, behavioural, and clinical effects of transcranial direct current stimulation in patients with a Prolonged Disorder of Consciousness; protocol for a double-blind randomised crossover feasibility study

2020 ◽  
Author(s):  
Davinia Fernández-Espejo ◽  
Davide Aloi ◽  
Antonio Incisa della Rocchetta ◽  
Damon Hoad ◽  
Richard Greenwood ◽  
...  
Keyword(s):  
Individual Differences ◽  
Feasibility Study ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Brain Activity ◽  
Brain Structures ◽  
Clinical Effects ◽  
Disorder Of Consciousness ◽  
Double Blind ◽  
Direct Current Stimulation

Abstract Background: Therapeutic options for patients with prolonged disorders of consciousness (PDOC) are very limited, and patients often show little to no progress over time. It is widely recognized that some PDOC patients retain a higher level of cognition that may be apparent on the basis of their external responses, and simply are unable to produce purposeful motor behaviours. This dissociation has been linked to specific impairments in the motor network that lead to a reduction in thalamo-cortical coupling. Here, we will assess whether transcranial direct current stimulation (tDCS) can modulate thalamo-cortical coupling and improve patients’ responsiveness. We will focus on characterising the mechanisms of action of tDCS and the bases for potential individual differences in responsiveness to the stimulation across participants.Methods: This is a multi-centre double-blind randomised crossover feasibility study. It is divided into two streams: (a) MRI stream: 5 PDOC patients will complete 5 anodal, cathodal, and sham stimulation sessions (paired with passive mobilisation of the thumb) in separate weeks. We will measure brain activity and connectivity with functional magnetic resonance imaging and electroencephalography (EEG). We will look at brain structures to assess differences associated with responsiveness. (b) Bedside stream: 10 patients will complete one session of anodal or cathodal stimulation and one session of sham. We will measure brain activity and connectivity with EEG and we will conduct follow up assessments at 3 and 6 months. In both streams we will also look at changes in the clinical profile of patients with the Coma Recovery Scale Revised and in command following behaviour with electromyography and motion tracking. We will assess feasibility on measures of eligibility, recruitment, retention, and completion of tests.Discussion: This feasibility study is the first step towards developing personalised tDCS interventions to restore external responsiveness in PDOC patients. Our results will inform the design of a future trial fully powered for characterising neural, behavioural, and clinical effects of tDCS in PDOC as well as the mechanisms underlying individual differences in responsiveness.

Abstract P200: Transcranial Direct Current Stimulation in Post-Stroke Chronic Aphasia: A Double Blind Randomized Controlled Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Caroline Schnakers ◽  
Zhong Sheng Zheng ◽  
Henry Millan ◽  
Sharon Lee ◽  
Melissa Howard ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Superior Cerebellar Peduncle ◽  
Double Blind ◽  
Verbal Comprehension ◽  
Direct Current Stimulation ◽  
Post Stroke ◽  
Chronic Aphasia ◽  
Cerebellar Peduncle

Background: There is growing evidence even amongst those with chronic aphasia that transcranial direct current stimulation (tDCS) combined with behavioral speech therapy could boost language. However, current findings do not allow making strong recommendations for using tDCS in order to improve language in post-stroke aphasia. The efficacy of tDCS therefore still needs to be established using double-blind controlled randomized trials in large samples. Intervention: In this ongoing double-blind randomized placebo controlled trial study, participants were randomly assigned either to the tDCS group or to the sham group. Both groups had five consecutive days of 20 minutes session, using a FDA approved tDCS device (soterixmedical.com). Behavioral and neuroimaging data were performed the week before/after tDCS/sham intervention and again 3 months following treatment. Participants: 42 post-stroke patients with chronic aphasia (32 males; age: 61±11y; 0.9-18years post-injury; 32 ischemic stroke; 19 non-fluent aphasia). Eighteen patients were in the tDCS group. Main Outcome Measures: The Western Aphasia Battery-Revised (WAB-R), Communication Outcomes after Stroke, patient and family report (COAST). MRI Diffusion Tensor Imaging data (64 dir) were also collected. Statistical Analyses: Anova with repeated measures was used on the behavioral outcome measures with aphasia severity, age and time since injury as covariates in SPSS. The average fractional anisotropy (FA) and mean diffusivity (MD) were extracted per ROI from each participant and timepoint. Main Results: a) Behavioral. Groups differed, pre/post intervention, on the WAB-R total score, for the Auditory-Verbal Comprehension and Repetition subscores; b) Neuroimaging. Change in Spontaneous Speech and Auditory Verbal Comprehension negatively correlated with change in mean MD and FA, respectively, in Superior Cerebellar Peduncle for tDCS, but not sham. Conclusion: Our preliminary findings show a higher improvement in language functions (for both receptive and expressive language skills) in response to treatment (vs. sham). Neuroplasticity was observed in superior cerebellar peduncle in response to tDCS mediated language improvement.

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